Most people have heard of the prostate, but some may not know why it’s so important for men to get their prostate checked regularly to make sure it is free of cancer and other abnormalities. To understand, let’s start with the basics.
The prostate gland is part of the male reproductive system. It surrounds the urethra tube, which carries urine from the bladder and semen from the prostate. The prostate is typically walnut-sized in younger men, but it enlarges with aging, which may result in issues later in life.
Benign prostatic hyperplasia (BPH) is an abnormal overgrowth of the prostate. It occurs in 80 percent of men by the age of 80. Symptoms include difficulty with urination, weakness of the urinary stream and having to go multiple times at night.
Treatments vary from the use of medications such as alpha blockers (Flomax, Rapaflo) or inhibitors (Proscar, Avodart) to more invasive treatment such as laser prostatectomy or transurethral resection of the prostate. The majority of men, however, do not require any treatment since their symptoms are not severe enough to affect their lifestyle.
The greater danger is prostate cancer. It has become the most commonly diagnosed cancer in men and the second most common cause of cancer-related death in men, surpassed only by lung cancer. Patients with prostate cancer are usually asymptomatic in the early stages. Blood in the urine, pains or difficulty urinating can be present in advanced stages.
The diagnosis of prostate cancer depends mostly on the prostate-specific antigen (PSA) test, positive family history of prostate cancer and a rectal exam. A transrectal ultrasound and biopsy of the prostate usually establish the diagnosis.
Prostate cancer is usually slow-growing; however, it can also be a very aggressive disease. The treatment depends on the stage, how aggressive the cancer, and the age of the patient. It also ranges from observation or watchful waiting to radiation, focal therapy, hormonal manipulation and surgical removal.
Since the introduction of robotic surgery to remove the prostate, there has been a marked decrease in hospital stay, quicker recovery time and a decrease in the rate of blood transfusions. Robotic prostatectomy is the cornerstone in the treatment of the young, healthy patients with curable prostate disease.
The PSA screening test is a helpful tool in the early diagnosis of prostate cancer. The test measures the protein produced by cells, and a PSA level of greater than 4.0 mg/mL typically results in additional testing. The test results can be elevated in patients with BPH, inflammatory conditions of the prostate, instrumentation of the genitourinary tract, as well as prostate cancer. Since the test’s introduction in the early 1990s, the mortality rate of prostate cancer has decreased by 40 percent.
Recently, the PSA screening has come under fire because in some people it may not be cancer specific.
The American Urological Association suggests the following guidelines for screening:
• Men age 40 or older with increased risk of prostate cancer – specifically African-Americans and those with a family history of the cancer.
• All men between the ages of 54 and 69.
• Men over the age of 70 with greater-than-10-year life expectancy.
• All men with greater-than-10-year life expectancy who have an abnormal rectal exam.
• Men older than 60 with PSA less than 1.0 can have the screening at longer intervals.
• Men with lower urinary tract symptoms who have a life expectancy of greater than 10 years and if the diagnosis of prostate cancer can modify the management.
Recent innovations, specifically advances in genetic testing, will likely result in even better testing in the future, including the ability to distinguish between the slow-growing disease and the more aggressive one. Until then, I advise men to follow the guidelines of the American Urological Association.